300614108-6-28-2022-06-CC-KDEI-CFTRJT-20220628130429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300614108
Report Date: 06/28/2022
Date Signed: 06/28/2022 01:05:45 PM

Document Has Been Signed on 06/28/2022 01:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SAUSD/MITCHELL CDC		FACILITY NUMBER:	300614108
ADMINISTRATOR:	ORLANDO, KEELY		FACILITY TYPE:	850
ADDRESS:	3001 WEST HARVARD		TELEPHONE:	(714) 430-5600
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	17	CENSUS: 0	DATE:	06/28/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Ms. Berber, Veronica : Early Education Specialist		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection at the above facility for the purpose of Increasing the Preschool capacity in the current licensed room # 402. Facility is requesting to increase the capacity to 24 children. This classroom is a State Preschool program and Special aid children are a part of this classroom. The facility is currently licensed for 17 preschool children. LPA Desai, Ketki met with Early Education Specialist Ms. Berber, Veronica who guided analyst on a tour of the facility. The facility is located on the Kenneth Mitchell Elementary school under Santa Ana Unified School district. Due to summer break, there were no children present in any of the classrooms. Currently the facility is operating from 8.00 am to 4.00 PM, Monday to Friday serving children ages 2-5 years old offering two half day sessions. Facility has a Waiver to use the School yards and bathrooms on file. Facility shall continue to offer two half day sessions in this room (AM session 8-10.30 am where Breakfast shall be served and PM session 12.30 to 2.00 PM :lunch shall be served. There will be no napping in the half day session) A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the nurse’s office, next to the school office, away from the other children, there is also a bathroom located in this area for the ill children to use. Continue on next page (1 of 2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/MITCHELL CDC	FACILITY NUMBER: 300614108
	VISIT DATE: 06/28/2022

NARRATIVE

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Medication will be stored in the classroom, located in a top cabinet. Incidental Medical services are provided. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. The facility provide water inside/outside by a water jug and disposal cups and children bring their own water bottles from home labeled with their names. First Aid supplies were inventoried.

Center provides breakfast for AM session and Lunch for the afternoon session, all food is delivered to the the facility by the school district cafeteria.

Following was observed in all the current classroom # 402.
1) Age appropriate furniture and activities including Educational / Arts & Crafts items.
2) Room is well ventilated with proper lighting and shade.
3) There is a working Smoke detector / Carbon Monoxide detectors and Fire Extinguisher.
4) There are age appropriate toilets and sinks inside the classroom for easy access.
5) Parent drop off - pick up: Designated gate in front of the office. Electronic sign in using a specific Pin number and manual sign in also available.

Indoor activity space: 1194'41 divided by 35= 34'13 (34 children) Facility has sufficient space to accommodate the requested capacity of 24 children in Room # 402.

Total sinks : 5 X 15 = 75 children / Toilets: 3 x 15= 45 children ( Additional sinks and toilets are available on school campus. There are designated toilets and sinks for the preschool age children inside the bathrooms)

Outdoor Activity Space: Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment. Adequate shade is provided by Canopies and trees. The play yard shall be shared with the Kindergarten and Special Aid education program children.
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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/MITCHELL CDC	FACILITY NUMBER: 300614108
	VISIT DATE: 06/28/2022

NARRATIVE

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Fire clearance approval letter on file and dated 06/23/2022, approving the requested capacity.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

New License with a capacity of 24 preschool age children (2-5 years) in Room # 402
Monday To Friday 8.00 am - 4.00 PM .
Room # 402 : Two half day sessions (8-10.30 am & PM session: 12.30 to 2.00 PM)
Inclusive program is incorporated into the class.
Above license shall be issued upon Management approval.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC809 (FAS) - (06/04)

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